Neurosurgery Coding Alert

Test yourself with these 6 questions about the edits, deletions and additions

If you-re still trying to get a grip on the changes in the 2006 CPT, take this quiz. These questions will test just how well you understand the new kyphoplasty and drug administration changes. 

Hint: You can find all the quiz answers in the CPT Update 2006 articles in the December 2005 issue.

Question 1: Which of the following codes would you use to report a kyphoplasty procedure a neurosurgeon performs on a single lumbar vertebral body?

A. 22523
B. 22524
C. S2362
D. All of the above
E. None of the above

Question 2: An internist asks a neurosurgeon to perform a consultation for a patient in the hospital who is exhibiting a change in mental status. Three days later during the same inpatient stay, the neurosurgeon checks on the patient and provides subsequent neurological care. Which of the following coding scenarios might be appropriate for reporting these visits in 2006?

A. 99253 for the first visit and 99261 for the second
B. 99261 for the first visit and 99231 for the second
C. 99253 for the first visit and 99231 for the second
D. All of the above
E. None of the above

Question 3: True or false: Two additional codes will help you differentiate the complexity and class of incision and drainage procedures a neurosurgeon performs.

Question 4: Which CPT code should you report when the neurosurgeon must re-open and drain a patient's wound due to an infection during the postoperative period of a C3-C7 posterior spinal fusion?

A. 10140
B. 10061
C. 22010
D. 22010-78
E. None of the above

Question 5: A neurosurgeon performs a balloon dilation in the innominate family and then an additional balloon dilation in the right carotid artery. How should you report this using the new codes?

A. 61640 and 61641
B. 61640 and 61642
C. 61640 x 2
D. Just 61640
E. None of the above

Question 6: True or false: In 2006, you should report 96115 for neurobehavioral status exams.
 

Answer 1: B. CPT created three kyphoplasty procedure codes this year. For lumbar kyphoplasty on a single level, use 22524 (Percutaneous vertebral augmentation, including cavity creation [fracture reduction and bone biopsy included when performed] using mechanical device, one vertebral body, unilateral or bilateral cannulation [e.g., kyphoplasty]; lumbar).

But if the neurosurgeon performed a thoracic kyphoplasty, report 22523 (Percutaneous vertebral augmentation, including cavity creation [fracture reduction and bone biopsy included when performed] using mechanical device, one vertebral body, unilateral or bilateral cannulation [e.g., kyphoplasty]; thoracic).

The third new kyphoplasty code is an add-on code: +22525 (- each additional thoracic or lumbar vertebral body [list separately in addition to code for primary procedure]). Code S2362 (Kyphoplasty, one vertebral body, unilateral or bilateral injection) is one of the two HCPCS codes you had to use prior to Jan. 1 to report kyphoplasty procedures.

Answer 2: C. Given the appropriate levels of service, 99253 (Initial inpatient consultation for a new or established patient ...) and 99231 (Subsequent hospital care, per day, for the evaluation and management of a patient ...) would be appropriate codes for the scenario given. CPT 2006 deleted follow-up consultation codes 99261-99263 (Follow-up inpatient consultation for an established patient ...). You should now report initial consultations in the inpatient setting using 99251-99255, and follow-up inpatient consultations using subsequent hospital care codes 99231-99233.

Answer 3: True. CPT 2006 adds codes 22010 (Incision and drainage, open, of deep abscess [subfascial], posterior spine; cervical, thoracic, or cervicothoracic) and 22015 (- lumbar, sacral, or lumbosacral). These two additional codes will help coders more accurately report I&D procedures that neurosurgeons perform. 

Answer 4: D. When the neurosurgeon must re-open and drain a patient's wound due to an infection during the postoperative period of a C3-C7 posterior spinal fusion, you should report 22010 (Incision and drainage, open, of deep abscess [subfascial], posterior spine; cervical, thoracic, or cervicothoracic).

Be sure to append modifier 78 (Return to the operating room for a related procedure during the postoperative period) to indicate that the I&D procedure was related to the original surgical procedure. Code 10061 (Incision and drainage of abscess [e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia]; complicated or multiple) is for non-postoperative I&D procedures.

Code 10140 (Incision and drainage of hematoma, seroma or fluid collection) is for superficial I&D procedures of a hemotoma at an unspecified location.

Answer 5: B. You should report 61640 (Balloon dilatation of intracranial vasospasm, percutaneous; initial vessel) when your neurosurgeon performs a balloon dilation in any one of these families.

If the physician does multiple dilations in different vessels in a single family, you should report +61641 (- each additional vessel in same vascular family [list separately in addition to code for primary procedure]) for the additional procedures (a different vessel is one that is beyond any bifurcation in the artery).

Use +61642 (- each additional vessel in different vascular family [list separately in addition to code for primary procedure]) when he moves into a second vascular family.

Answer 6: False. As of January 2006, the American Medical Association replaced 96115 (Neurobehavioral status exam [clinical assessment of thinking, reasoning and judgment, e.g., acquired knowledge, attention, memory, visual spatial abilities, language functions, planning] with interpretation and report, per hour) with a new code: 96116 (Neurobehavioral status exam [clinical assessment of thinking, reasoning and judgment, e.g., acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities], per hour of the psychologist's or physician's time, both face-to-face time with the patient and time  interpreting test results and preparing the report).

Answers reviewed by Eric Sandhusen, CHC, CPC, director of compliance for the Columbia University department of surgery.